Tom writes “Dr. Eddie, I am really struggling with particular thoughts that come into my head and actions that I do. Let me explain I am 47 years old, have a lovely wife and two wonderful children one working and the other in in college. I almost own my home and carry little debt, have a group of close friends and family. While this all sounds wonderful, at work it’s a different story I am under pressure and work for a boss who is a jerk, he increases the workload and shortens the deadlines. I don’t sand up to him.  I think I am cracking up, I find it hard to take pressure. Now I am not talking about harming myself or anything like that, I am just finding it so hard.   Indeed it’s a relief to be writing this down and seeking advice.

I am having a lot of bad thoughts in my mind about hurting people that I love, and strangely not my boss. I try to block these thoughts from coming into my head, but they keep coming. Previously when I had this level of stress I had these thoughts before I found counting in my head to help.  I count backwards from 50 and if I miss a number or think I have missed a number then I start again and again. Also I like to put things in an orderly manner at home and in work. I need things to be in order and this can cause conflict at home if family members disturb my perfect placement.  While putting things in straight lines and counting has helped me it’s totally exhausting. My mood has dropped, I have lost interest in everything and its impacting on my life. My family are worried about me, and too be honest I am very worried about the thoughts I am having. Any advice appreciated, thanks.    

Hi Tom, thanks very much for contacting. From the outset my advice is for you to go to your GP for onward referral, assessment and treatment to a mental health practitioner.  Let me explain first of all these thoughts are “obsessional thoughts” and they can be tormenting. Having sat in a therapy room for almost 20 years I can tell you that most people have strange intrusive thoughts at times.  Obsessional thoughts are different as they are intrusive, persistent and pervasive.  With obsessional thoughts they can emerge during times of great stress, as you describe currently with the relationship with your boss.  People who experience obsessional thoughts they are often violence, religious (blasphemous) or sexual in nature. Typical examples are ‘killing someone, jumping in front of a train or bus, harming a child, shouting expletives in a church’. My experience is that these thoughts are opposite your true nature i.e. peace loving people have violent images, very religious people have blasphemous intrusive thoughts and gentle loving people have intrusive thoughts around sexual violence.

Let me be clear Tom, while these thoughts are embarrassing and frightening, they are intrusive. It’s like when you are pushing a ball under water it will eventually pop up, its intrusive. They are the opposite of your nature. You will not act out on these thoughts, the greatest myth is that having thoughts of a violent nature mean that you want to do the things that come into your mind. This is not true. Tom, the content of your thought does not count. It is irrelevant. Your thoughts have no effect on what you will do. A thought, even a very scary thought is not an impulse. You will not act on your intrusive obsessive thoughts.

Tasks around managing intrusive thoughts guided by your therapist will include advice not to engage your thoughts, such as reasoning with them, pushing them away, altering your behaviour to stay away from threatening situations, as all these approaches will only serve to make your thoughts stronger and more intrusive. As with other forms of anxiety, your job is to do the opposite –

  • Label these thoughts as “intrusive obsessive thoughts.”
  • Remind yourself that these thoughts are automatic and you can safely ignore them.
  • Accept and allow the thoughts into your mind. Do not try to push them away
  • Continue whatever you were doing prior to the intrusive thought.

It seems your problem is an anxiety issue, probably Obsessive Compulsive presentation associated with excessive stress. Very often when a person has a distressing thought they use a behaviour to get relief – counting or ordering stuff is this behaviour. This OCD behaviour takes a huge amount of negative energy and impacts on your mood and on your family life. It would be helpful to talk to your wife so she can understand the distress that you are experiencing.

Hence my advice is to go to your GP and get a referral. Tackling obsessional compulsive behaviours is very successful. In this space you will develop the opportunity to develop skills on addressing the triggers, such as development of assertive skills to manage work based stress and your loss of interest.  Like all things early intervention is the key so act now.